CROI 2017: Targeted testing needed to reach 2020 goal, stronger systems needed to rise to the ensuing challenge

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Science Speaks is covering the 2017 Conference on Retroviruses and Opportunistic Infections in Seattle Washington live this week, from February 13-16, with breaking news on HIV research findings and implications.

Findings from first three of 13 countries in the Population-based HIV Impact Assessment show significant progress, highlight need for focused outreach

SEATTLE – Zambia, Zimbabwe and Malawi, neighboring countries all hit hard by HIV across their populations, have all made similar strides that go beyond dropping numbers of new infections to rising numbers of people getting the antiretroviral care they need, and rising numbers of people for whom that care is effective.

The first data from PHIA — Population-based HIV Impact Assessment —  an effort to quantify the effectiveness of efforts on the ground, through household interviews and blood tests, revealed substantial progress toward two of three goals that UNAIDS has projected must be reached by 2020 to control HIV by 2030. Those goals call for 90 percent of people living with HIV being aware of their infection, for 90 percent of them to receive antiretroviral treatment, and for treatment to be effective enough to suppress the virus in 90 percent of them. Combined, and similar findings across the three countries found 87 percent of people who knew they were living with HIV were receiving treatment, and among 88.6 percent of them, treatment was successfully suppressing the virus. The only significant shortfall was found in the first of the goals, with just slightly more than 70 percent of people who tested positive for the virus during household surveys being aware of their diagnosis beforehand. While that represents a great improvement over rates of just a few years earlier, findings that 30 percent of people with HIV surveyed and tested were unaware of their infection, with the majority of them male, represent a bottleneck that unaddressed would slow epidemic control. While showing a diminishing epidemic overall, the findings highlight the need for testing that reaches those being missed now, and for continued work to ensure health systems can then meet the demonstrated needs for successful treatment.

“The way forward will require keeping our foot on the pedal,” Jessica Justman, presenting the findings for ICAP at Columbia University, said.

The conclusion was echoed by projections from modeling presented by Jack Olney of the Imperial College of London, analyzing existing data in Zimbabwe, and concluding that while 50,000 people living with HIV were being diagnosed on a yearly basis there currently, an additional 11,000 more HIV diagnoses would have to be made to reach 90-90-90 goals. He emphasized that improved data collection would support efforts to better tailor services to those living with HIV, but unaware of it.

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